WORC - Enhancing Rural Workforce Cohort #3 Application

The Center on Rural Innovation is excited to launch our “Enhancing Rural Workforce Capacity Through Tech-Driven Development” initiative - a 9-month PAID tech training program designed to address technology talent gaps in the rural communities of Chambers County, AL, Portsmouth, OH, & Springfield, VT. Applications for this Cohort are due by Friday, March 20th.

Please contact Program Manager, Cameryn Mitchell (Cameryn.mitchell@ruralinnovation.us) if you have questions.

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* 1. First Name

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* 2. Last Name

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* 3. Which community do you live in?

Chambers County, Alabama

Portsmouth, Ohio

Springfield, Vermont

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* 4. Current Mailing Address

Address Line 1 *

Address Line 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

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* 5. Email Address

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* 6. Phone Number

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* 7. Date of Birth

Date

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* 8. What is your gender?

Male

Female

Non-binary

Other (please specify)

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* 9. What pronouns do you use?

He/his

She/her

They/their

Other (please specify)

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* 10. What is your ethnicity and/or race? (Please select all that apply.)

American Indian or Alaskan Native

Asian or Pacific Islander

Black or African American

Hispanic, Latino/a, or of Spanish origin

Middle Eastern or North African

White / Caucasian

Prefer not to answer

Other (please specify)

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* 11. Are you a veteran of the United States Armed Forces?

Yes

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* 12. What is your current employment status?

Employed, full-time

Employer, part-time

Self-employed

Unemployed

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* 13. What is your approximate monthly income?

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* 14. Do you have regular access to a computer?

Yes

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* 15. Do you currently have internet access?

Yes

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* 16. Which certification path are you interested in pursuing?

Cybersecurity Track

Networking Track